Heart Disease: Many types, many tests
BY BARB FABER, NP
Ministry Medical Group/Ascension Rhinelander
More than 26 million Americans–about 11 percent of the population–have heart disease; and most of the rest of us have at least one or two risk factors. That’s why doctors use tests to look beyond the symptoms and discover exactly how your heart is performing.
There are many types of heart disease and many tests to help doctors diagnose and manage them.
CARDIOVASCULAR DISEASE: Blood vessels become narrowed or blocked by plaque, a process known as atherosclerosis. Or they can become stiff and less able to dilate and narrow as they should.
When disease occurs in coronary arteries near the heart, symptoms such as chest pain, shortness of breath or fatigue may be a sign that a heart attack is imminent.
CHOLESTEROL TEST: The most common test for cardiovascular disease is a blood test that measures levels of total cholesterol, LDL, HDL and triglycerides. High levels of LDL and/or low levels of HDL might require treatment with a cholesterol-lowering medication.
A cholesterol test allows early detection of cardiovascular disease when symptoms have not occurred. Angina, recurring or acute chest pain caused by reduced blood flow to the heart muscle, is a late sign that must be taken seriously.
What’s known as stable angina occurs when you are exerting yourself and disappears when you rest. Unstable angina is usually more severe and longer lasting and may occur even at rest. This may mean that a heart attack is imminent.
Doctors have several tests to diagnose angina.
AN ELECTROCARDIOGRAM (OR EKG) traces the electrical signals that cause the heart to beat. By looking at the pattern of your heart beats, the doctor can tell if the blood flowing through your heart has been slowed, interrupted or is simply not getting to the heart.
BLOOD TESTS: As heart muscle cells die during a heart attack, they release proteins into the blood stream. Higher than normal levels of these proteins can confirm a heart attack.
CORONARY ANGIOGRAPHY is a test using dye and special x-rays showing the inside of coronary arteries. Often used during a heart attack, this test can help the doctor locate the blockage.
It is performed using a thin tube or catheter inserted into a blood vessel in the arm, groin or neck and threaded through the vessel until it reaches the coronary artery.
If you have angina but are not having a heart attack, other tests may be used for diagnosis.
STRESS TEST: A stress test allows a doctor to see what happens to your heart while you are walking on a treadmill or pedaling on an exercise bike. A nuclear stress test uses a radioactive substance injected into the blood stream to create images of the heart that show where blood flow is inadequate.
ECHOCARDIOGRAM: An echocardiogram uses sound waves to produce images of the heart that can reveal areas that may have been damaged by poor blood flow.
HEART ARRHYTHMIAS: No matter how clean and clear your blood vessels may be, you can have heart disease caused by an abnormal rhythm. Some patients with atrial fibrillation have very rapid heart beats that send them to the hospital. Many, though, have no symptoms.
The EKG is the basic test for diagnosing arrhythmia. But since the arrhythmia often comes and goes, the patient may need to wear a Holter monitor or an event monitor to record EKG results over a 24-hour period or, in the case of the event monitor, when suspicious symptoms appear.
HEART FAILURE means the heart has become weakened and is unable to pump blood effectively. This can be a consequence of a heart attack, a valve problem or arrhythmia.
Tests commonly ordered for diagnosis and treatment are the ones used for other types of heart disease: EKG, chest x-ray, echocardiogram, exercise stress test, cardiac catheterization.
VALVULAR HEART DISEASE is related to one or more of the four valves of the heart. These valves can become dysfunctional as a result of a congenital birth defect, rheumatic fever, atherosclerosis, high blood pressure, damage from a heart attack or aging.
Your doctor will listen for heart murmurs and may order tests such as EKG, echocardiogram and exercise stress test. Cardiac catheterization can be very useful in determining the pressure that goes through the valves. And catheterization can also be used to widen a valve that has become narrowed or even to replace it.
With any type of heart disease, you may or may not have symptoms. With the aid of tests, your primary care clinician or specialist can be reasonably certain about diagnosis and treatment.